High-risk Babies Research Articles

Hearing loss in high risk neonates

Objective: To determine the incidence and risk factors associated with hearing loss in high risk neonates. Design: Descriptive cross sectional study. Setting: Level II NICU of a tertiary care hospital. Participants: 280 high risk infants were screened. Intervention: All high-risk babies were initially screened with both transient evoked otoacoustic emissions (TOAE) and Auditory brainstem response (ABR). Outcome variables: Primary: to determine the incidence of auditory neuropathy in high risk infants; Secondary: risk factors in those babies identified with hearing loss. Results: Incidence of hearing loss was 17.8 per 1000 screened (95% C.I is 0.24% - 3.32%), with bilateral hearing loss seen in 14.2 per 1000 babies. Highest incidence of hearing loss was seen is in infants with intracranial haemorrhage and meningitis (50%) followed by in decreasing orders craniofacial anomalies (20%), intrauterine congenital infections (11.11%), culture positive sepsis including meningitis (8.88%), birth weight less than 1.5 kg (7.14%), preterm < 33 weeks (4.34%), severe birth asphyxia (4%), use of ototoxic medications for more than 5 days (3.03%). The risk of hearing loss is higher with higher number of risk factors. With a single risk factor being present, it is only 0.66%, whereas with five risk factors, the incidence was 33.3%. Conclusion: There is a high incidence of hearing loss in at-risk infants. Hearing loss is commoner when risk factors such as intracranial haemorrhage or meningitis are present and with presence of multiple risk factors. This would justify the need to routinely screen all high risk infants, so that rehabilitative measures can be initiated at the earliest.

74. Screening high risk babies with Auditory Brainstem Responses and Multiple Auditory Steady State Responses

Objective Evaluate the results of the hearing screening program organized and applied in the “William Soler” Paediatric Hospital, targeting multiple high-risk groups. Material and methods The children were evaluated using click Auditory Brainstem Responses (ABR with Multiple Auditory Steady State Responses (MSSR) (0.5 and 2 kHz). The possible causes of hearing impairment were examined comparatively. Results The results shows an overall incidence of permanent hearing losses of 3,3% in the high risk population with referral rates of around 10%. The common perinatal causes of hearing losses were low birth weight; foetal suffering and the use of ototoxic drugs have remained very frequent. Conclusions The incidence of hearing impairment and the referral rates were quite comparable to those reported in the high risk population by similar screening protocols. It is found some variations in the current causes of hearing losses when comparing the early and late periods (before and after 1990) of the screening program. Significance This hearing screening program with Auditory Brainstem Responses (ABR) and Multiple Auditory Steady State Responses (MSSR) shows a high grade of efficiency and sensibility in programs to early detection of hearing deafness.

73. Hearing screening using auditory steady state responses obtained by simultaneous air- and bone-conduction stimuli

Objective Our objective was to evaluate the efficiency of an automated hearing screening test based on auditory steady state responses obtained using simultaneous air- and bone-conduction stimuli. Material and methods A sample of 80 high risk babies lees than 2 months of born were screened using the automatic screening test. A confirmatory clinical and electrophysiological evaluation was used as the gold standard. Results The estimated diagnostic efficiency of this screening test was equivalent (100% sensitivity and 97.7% specificity) to the efficiency reported for otoacoustic emissions and automated auditory brainstem responses. The introduction of bone conduction in the screening reduced the false positive rate from 13.3% to 2.2%. The test duration was 5.3 ( ± 1.9) min. In 34% of babies, only one repetition of the test was needed to raising the result. Conclusions The screening test performed quite well in this initial clinical trial, differentiating transient conductive hearing losses from permanent neurosensory impairments, reducing the number of positive false cases. Significance This test permits to improve the diagnostic efficiency of auditory steady state responses.

Incidence and Risk factors of Retinopathy of Prematurity in Tertiary Care Centre of Western India

Aim: This study is aimed to estimate the incidence of retinopathy of prematurity and to identify the risk factors which predispose to retinopathy of prematurity. Material & Methods: The present prospective study was conducted at Ophthalmology department of tertiary care centre in Aurangabad, India from September 2010 to May 2013. Total 150 preterm infants admitted to the neonatal intensive care unit or discharged were included in this study. Diagnosis of ROP was done by binocular indirect ophthalmoscopy and graded into stages and zones as per the international classification of ROP. The data was analysed by using the SPSS-23 program and applying the chi-square test. Results: Of the total 150 infants screened, ROP was seen in 71 infants with the overall incidence of 47.33 %. The stage I ROP was with the highest incidence (22%), followed by decreased incidence pattern in stages II, III, IVa. There were no patients with stage V. The highest percentage of retinopathy of prematurity was seen in infants with gestational age < 28 weeks and extremely low birth weight (<1000 g) infants. The oxygen administration for more than 2 days (p= 0.0001), sepsis (p=0.001), intraventricular haemorrhage (p=0.001), blood transfusion (p=0.001) and respiratory distress syndrome (p=0.01) were found to be statistically significant for the development of retinopathy of prematurity. Conclusion: All high risk babies should be screened for ROP as early screening and intervention can help to increase the child’s chances of better vision and hence better quality of life and also reduce the load of paediatric blindness due to ROP.

Reduced wave amplitudes of brainstem auditory response in high-risk babies born at 28–32 week gestation

ObjectiveTo examine brainstem auditory electrophysiology in high-risk babies born at 28–32week gestation by analysing the amplitudes of wave components in maximum length sequence brainstem auditory evoked response (MLS BAER). Methods94 preterm babies, ranging in gestation 28–32weeks, with perinatal problems (high-risk) were recruited. The amplitudes of MLS BAER wave components were studied at term age (37–42weeks postconceptional age). ResultsCompared with normal term controls, the amplitude in the high-risk preterm babies was significantly smaller at the highest click rate 910/s for wave I (p<0.01), at all 91–910/s for wave III (all p<0.01) and at 455 and 910/s (p<0.05 and 0.01) for wave V. Compared with age-matched low-risk preterm controls, the amplitude was significantly smaller at 455 and 910/s for wave I (p<0.05 and 0.05), 91–910/s for wave III (p<0.05–0.001), and 227–910/s (p<0.05 and 0.01) for wave V. No differences in the V/I and V/III amplitude ratios were found between the high-risk preterm babies and the controls. ConclusionsThe amplitudes of MLS BAER wave components, mainly more central components, were reduced in the high-risk preterm babies born at 28–32week gestation. Electrophysiological activity of the brainstem auditory neuron in such babies is depressed, mainly attributed to or related to the associated perinatal problems.

Small-for-gestation birth exerts a minor additional effect on functional impairment of the auditory brainstem in high-risk babies born at late preterm

To address if small-for-gestational-age (SGA) significantly affects the developing auditory brainstem in late preterm babies with perinatal problems (i.e. high-risk), providing valuable information for management of such babies. SGA and appropriate-for-gestational age (AGA) babies born at 33-36weeks of gestation were studied at term using maximum length sequence brainstem auditory evoked response in response to 91-910/s clicks. Compared with AGA late preterm babies without perinatal problems (i.e. low-risk), the high-risk SGA babies manifested a significant increase in wave V latency and I-V interval at all 91-910/s clicks, and III-V interval at 455 and 910/s. The amplitude was smaller for wave I at 227 and 910/s, wave III at 910/s and wave V at 227 and 910/s. Compared with low-risk SGA babies, the high-risk SGA babies showed similarly abnormalities. Compared with high-risk AGA babies, the high-risk SGA babies manifested slightly different abnormalities. Brainstem auditory response was abnormal in high-risk SGA late preterm babies. The abnormalities, suggesting brainstem auditory impairment, were slightly different from high-risk AGA late preterm babies. SGA birth exerts a minor additional effect on the impaired auditory brainstem in high-risk babies born at late preterm. For these babies, neuroprotective measures should mainly target at associated perinatal problems, although the relatively minor adverse SGA effect cannot be ignored.

Prevalence of hearing impairment among high risk neonates- A hospital based screening study

Background and objectives: Hearing loss present at birth is one of the major disabilities in childhood, the early detection of which can prevent further disability in speech, language and cognition. The prevalence of congenital hearing loss has been estimated to be 1.2 5.7 per thousand live births and is more among high risk neonates. In this context the present study was conducted as an attempt to find the prevalence of hearing loss among high risk neonates and the associated risk factors. Methodology: The present study was a hospital based cross sectional study conducted at a tertiary care centre in Trivandrum, Kerala during the period of November 2012 to October 2014. A total of 231 high risk babies were assessed by 2 staged DPOAE screening and those who failed the second stage DPOAE screening were subjected to diagnostic Brainstem Evoked Response Audiometry. Results: 0.9% of the high risk babies had hearing loss. Both the neonates who had sensorineural hearing loss were males and had identifiable risk factors, such as hyperbilirubinemia, ototoxicity, neurological deficits and congenital malformation. Conclusion: The two staged screening protocol with Distortion Product Otoacoustic Emission and confirmation by Brainstem Evoked Response Audiometry was found to be a useful tool in detecting hearing loss in newborn. Hence the results of this study will be used to initiate universal newborn hearing screening in our hospital. Moreover our study highlights the relevance of neonatal hearing screening in our country where this screening is not performed routinely in all hospitals.

CDC Kerala--The Untold Story.

This article is our life time experience in conceptualizing and systematically developing Child Development Centre (CDC) Kerala in the last 25 years, from a research project to a national training centre in child and adolescent development and premarital counseling. CDC Kerala's major contribution was in creating a 'conceptual framework' of a valid link between childhood disability, low birth weight, adolescent girls' nutrition and fetal onset adult lifestyle diseases. It all started with a randomized controlled trial (RCT) proving beyond doubt that early stimulation is effective in improving the neurodevelopmental status of high risk babies at one and two years and the same cohort was followed-up in detail at 5, 13, 16, 19 and 24 completed years. The process of establishing CDC Kerala is being presented under (i) clinical child development, (ii) adolescent care counseling, (iii) young adults and premarital counseling and (iv) institution building.

How Do Patients Evaluate the New Health Care System in General Practice? Results from the European Project on Patient Evaluation of General Practice Care (Europep) in Adana, Turkey

Background : Birth weight has been accepted as the most important reliable index of the health status of the community and is an indicator of neonatal morbidity and mortality. In India weight at birth is not recorded because almost 80% of the deliveries take place at home or at rural health centre where weighing scales tend to be either non available or defective. Objective: To find the best surrogate parameter to determine birth weight and cut off values of various anthropometric measurements to identify low birth weight babies. Material and Methods : All the term babies born in Krishna hospital, Karad were weighed at birth and measured within 24 hours of delivery with the help of a flexible non stretchable measuring tape capable of measuring up to 0.1 cm. Results: 1028 newborn infants were included in the study period of two years. Chest circumference and thigh circumference are among the best surrogate parameters to identify low birth weight babies. The cut off value of chest circumference was 30.4 cms and 30.6 cms and thigh circumference was 13.6 cms and 13.8 cms in male and female neonates respectively. Conclusion: These parameter can be used at community level by health workers for identification of high risk and low birth weight babies so that their timely referral can thereby help in reducing infant mortality in rural areas.

Disparity between Clinical and Ultrasound Examinations in Neonatal Hip Screening.

BackgroundFor early detection of developmental dysplasia of the hip (DDH), neonatal hip screening using clinical examination and/or ultrasound has been recommended. Although there have been many studies on the reliability of both screening techniques, there is still controversy in the screening strategies; clinical vs. selective or universal ultrasound screening. To determine the screening strategy, we assessed the agreement among the methods; clinical examination by an experienced pediatric orthopedic surgeon, sonographic morphology, and sonographic stability.MethodsFrom January 2004 to June 2009, a single experienced pediatric orthopedic surgeon performed clinical hip screenings for 2,686 infants in the neonatal unit and 43 infants who were referred due to impressions of hip dysplasia before 3 months of age. Among them, 156 clinically unstable or high-risk babies selectively received bilateral hip ultrasound examinations performed by the same surgeon using the modified Graf method. The results were analyzed statistically to detect any correlations between the clinical and sonographic findings.ResultsAlthough a single experienced orthopedic surgeon conducted all examinations, we detected only a limited relationship between the results of clinical and ultrasound examinations. Ninety-three percent of the clinically subluxatable hips were normal or immature based on static ultrasound examination, and 74% of dislocating hips and 67% of limited abduction hips presented with the morphology below Graf IIa. A total of 80% of clinically subluxatable, 42% of dislocating and 67% of limited abduction hips appeared stable or exhibited minor instability on dynamic ultrasound examination. About 7% of clinically normal hips were abnormal upon ultrasound examination; 5% showed major instability and 3% showed dysplasia above Graf IIc. Clinical stability had small coefficients between ultrasound examinations; 0.39 for sonographic stability and 0.37 for sonographic morphology. Between sonographic stability and morphology, although 71% of hips with major instability showed normal or immature morphology according to static ultrasound examination, the coefficient was as high as 0.64.ConclusionsDiscrepancies between clinical and ultrasound examinations were present even if almost all of the exams were performed by a single experienced pediatric orthopedic surgeon. In relation to screening for DDH, it is recommended that both sonographic morphology and stability be checked in addition to clinical examination.

Prevalence and referral rates in neonatal hearing screening program using two step hearing screening protocol in Chennai – A prospective study

ObjectiveTo estimate the prevalence and referral rates in well born and high risk babies using two step hearing screening protocol with Distortion Product Otoacoustic Emissions (DPOAE) and Automated Auditory Brainstem Response (AABR). MethodA prospective study was carried out on 1405 neonates (983 well born babies and 422 high risk babies) who were screened during May 2013 to January 2015 at Institute of Obstetrics and Gynecology, Madras Medical College, Chennai. All neonates were screened using two step screening protocol. They were initially tested with DPOAE. Referred babies in DPOAE were screened with AABR subsequently. ResultsAmong 1405 (100%) neonates 983 (69.96%) were well born babies and 422 (30.03%) were high risk babies. Total referral rate in DPOAE was found to be 311 (22.13%) among which 195 (13.87%) were well born babies and 116 (8.25%) were high risk babies. Out of 311 babies 31 (2.20%) babies were referred in AABR screening. In 31 babies referred in AABR 11(0.78%) were from well born group and 20 (1.42%) were from the high risk group. Further diagnostic evaluation of these babies, 2 (0.14%) were confirmed to have hearing loss. This study reveals, the prevalence of congenital hearing loss in our population is 1.42 per 1000 babies. ConclusionUsing two step protocol especially AABR along with DPOAE at the initial level of testing significantly reduces referral rates in new born screening programs. Also AABR decreases the false positive responses hence increasing the efficiency of screening program.

EEG and the newborn

Despite the evolution of new technologies for assessing neonatal brain function, electroencephalography (EEG) remains a powerful tool for neurological diagnosis and prognosis in neonates. It is considered the gold standard for distinguishing epileptic seizures from non-epileptic paroxysmal events and for detecting subclinical seizure activity in high-risk babies. In those babies severely ill, EEG is even more efficient as predictive test than the neurological examination. The prognostic value of neonatal EEG has been long recognized in term as well as in preterm infants. Background patterns, more that patterns of ictal discharges, correlate significantly with the long-term outcome. Although most abnormalities on the neonatal EEG are nonspecific, certain patterns can be highly suggestive for diagnosis. Prognostic value can be increased by obtaining early recordings, possibly within the first 48 hr of life, prolonged recordings to include samples of different activity states, and serial EEGs at short intervals to assess rapid changes that are likely to occur in high-risk infants. It is important to distinguish neonatal seizures from neonatal-onset epilepsies and epilepsy syndromes. Both benign and malignant neonatal epilepsy syndromes exist. While benign familial neonatal seizures represents a neonatal syndrome with benign outcome, early myoclonic encephalopathy and Ohtahara syndrome are the earliest form of age-dependent severe epilepsy syndromes. Early myoclonic encephalopathy and Ohtahara syndrome are both characterized by the presence of a burst-suppression EEG pattern. This pattern is usually associated with a poor prognosis and is considered the electroencephalographic correlate of a complete disconnection within the thalamocortical systems. Migrating partial seizures in infancy is a newly recognized epilepsy syndrome whose onset can be in the neonatal period. It is characterized by multifocal intractable seizures associated with psychomotor impairment. No etiology has been found so far. Different drugs currently used in neonatal intensive care unit, especially if in the toxic range, can alter the EEG background. Those effects need to be taken in account in the interpretation of neonatal EEG.

Universal Neonatal Hearing Screening - a Necessity and not a Choice

INTRODUCTION&#x0D; Congenital deafness in a child is often missed. Several distraction tests have evolved over time to diagnose congenital deafness. These are of limited value in the era of Evoked response audiometry. Evoked responses, such as Oto-acoustic emission (OAE) and Brainstem Evoked Response Audiometry (BERA) have played a significant role in early diagnosis of congenital hearing impairment. The study was conducted to compare the result of neonatal hearing screening in high risk and non high risk neonates.&#x0D; &#x0D; MATERIALS AND METHODS&#x0D; A study was conducted over a time period of three months at a tertiary care institute to screen all live neonates for congenital hearing impairment using OAE and BERA.&#x0D; &#x0D; RESULT&#x0D; 1182 neonates were screened for hearing impairment. 336 were in High risk group and rest in Non high risk group. Nine neonates turned out to have abnormal BERA result (absence of wave V). Six of them were high risk babies and rest 3 were non high risk.&#x0D; &#x0D; DISCUSSION&#x0D; 33.33% of congenital deaf population detected by UNHS belong to the Non High Risk group. Studies across the world suggest at least 50% chance of missing out a congenital deaf child if Universal Neonatal Hearing Screening is not practiced.&#x0D; &#x0D; CONCLUSION&#x0D; In order to ensure that early detection and effective intervention are made on all newborns with hearing impairment, UNHS should be performed. Three stage UNHS protocol using TEOAEs and BERA showed that the implementation of UNHS for congenital childhood hearing loss among all newborns in India feasible and effective.

G207(P) To review the outcome of hip screening ultrasound scan (uss) for developmental dysplasia of hip (ddh) in high risk babies

<h3>Aim</h3> The aim of our study was to review the outcome of hip screening ultrasound scan in high risk babies for further evaluation of developmental dysplasia of hip in the district general hospital. <h3>Methods</h3> This is a retrospective study. We looked at the outcome of the USS hip performed for the period of 18 months from June 2013 to October 2014 in our trust in high risk patient group with breech presentation, family history of DDH, twin deliveries with one of the twin born with breech presentation and on the clinical suspicion after clinical examination of the hip. Data was collected using hospital notes, PACS system was used for USS results. <h3>Results</h3> In total 553 USS hip was performed for further evaluation of DDH out of which only 4 scans were abnormal. Three of this abnormal scans were in babies born with breech presentation and one was in a baby who’s mother had history of DDH needed intervention in past. Out of this 4 abnormal scans 3 scans were Graf Type IIa and one was Graf type D. <h3>Conclusion</h3> In our experience we have observed a significantly low percentage of clinically relevant USS results for DDH even in selected high risk babies.

Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda

BackgroundIn Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities.ObjectiveThis paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme.DesignThis health system strengthening study, part of the Uganda Newborn Study (UNEST), aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening.ResultsSeventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase) in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC) unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with less than 40% of health facilities reporting no stock-outs.ConclusionHealth system strengthening for care at birth and the newborn period is possible even in low-resource settings and can be associated with improved utilisation and outcomes. Through a participatory process with wide engagement, training, and improvements to support supervision and logistics, health workers were able to change behaviours and practices for maternal and newborn care. Local solutions are needed to ensure sustainability of medical commodities.

Tele-ophthalmology in retinopathy of prematurity screening – A study from a referral government hospital

Objective: The aim was to assess the role of tele-ophthalmology in retinopathy of prematurity (ROP) screening and to identify the risk factors for ROP. Design: Prospective cohort study. Setting: Level 2 neonatal intensive care unit (NICU) at a Government Hospital in Davangere, Karnataka. Subjects: 381 babies born &lt;32 completed weeks of gestation admitted in NICU during study period. Methods: Examination of the eyes was done by a trained technician using a Ret Cam digital imaging, designed by The Karnataka Internet assisted Diagnosis ofROP, Narayana Nethralaya under the National Rural Health Mission scheme. It was later interpreted by a trained ophthalmologist using the concept of teleopthalmology. Babies were followed up and screened once weekly up to 3 months of age. Results: The overall incidence of ROP in our study was 25.2%. 3.8% of babies had Stage 1 disease, 3.8% had Stage 2, 53.8% had Stage 3, and 38.4% had Stage 4 disease. 34.2% of the babies who received oxygen therapy developed ROP. Anemia and respiratory distress syndrome have shown to significantlyincrease the risk of developing ROP. Two babies with ROP underwent light amplification by stimulated emission of radiation treatment and one baby underwent supplementary treatment. Conclusion: The incidence of ROP among high risk babies is significant and teleophthalmology can play a significant role in timely screening of babies in the remotest parts of the country. Oxygen therapy, anemia and respiratory distress syndrome were found to be significant independent factors predicting the development of ROP.

Predictive Value of Pupillary Response to Mydriatic Agents for Diagnosis of Retinopathy of Prematurity.

Purpose:To evaluate the feasibility of screening for retinopathy of prematurity (ROP) by assessing the pupillary response to mydriatics.Methods:This observational case series included 134 eyes of 67 premature infants with birth weight less than 2,000 grams and gestational age less than 33 weeks. A composite eye drop composed of phenylephrine 1%, tetracaine and tropicamide 0.5% was applied 3 times within 5-minute intervals and pupil diameters were measured. The eyes were examined by experienced ROP specialists using an indirect ophthalmoscope. Zone and stage of ROP, presence of plus disease and need for treatment were recorded. The relationship between the pupillary response to mydriatics, and presence and severity of ROP was evaluated. Logistic regression was used for statistical analysis.Results:According to receiver operating characteristic (ROC) curve analysis, final pupil diameter after mydriatic administration was found the most accurate factor among other factors to recognize ROP zone I from zones II and III (Area under ROC: 0.92 [95%CI: 0.85-0.98]). The best cutoff value for final pupil diameter was 5.6 mm, because it could differentiate involvement of zone I from zones II and III with sensitivity of 80% and specificity of 100%.Conclusion:Response of the pupil to mydriatic eye drops may be useful as a less invasive method for rough estimation of ROP in high risk babies who need emergent attention; however, it cannot be considered as a screening test due to its low sensitivity.

The Influence of Method, Timing of Onset and Duration of Enteral Feeding on the Duration of Hospitalization of Newborn Infants in a Nigerian Special Care Baby Unit.

Background:Feeding practices among high-risk newborn babies have not been extensively studied in the resource-constrained parts of the world.Aim:To describe the pattern of milk use among infants in a resource-poor special care baby unit (SCBU) and relate these to the outcome of hospitalization.Subjects and Methods:Setting – SCBU of Olabisi Onabanjo University Teaching Hospital, Sagamu. Design – Prospective study of consecutively admitted inborn babies within the first 24 h of life. The data analyzed included the weight and estimated gestational age (EGA) of the babies, the age at the onset of and duration of feeds (breast milk and artificial milk [AM]).Results:Out of the 118 infants studied, (78.8%) 93/118 received breast milk and 16.1% (19/118) received AM. The mean age at the commencement of enteral feeding was 3.9 days. The age at the onset of suckling was negatively correlated with the EGA and body weight. The age at the onset and duration of enteral feeding were directly related to the duration of admission.Conclusion:More than three-quarter of the infants hospitalized in the unit received breast milk, but commencement was mostly delayed beyond the 3rd day of life. The duration of admission may be related to the timing of onset and duration of milk use.

Hearing screening in a tertiary care hospital in India.

To study the incidence of hearing loss among children and to determine and confirm the distribution of common risk factors in children with hearing loss presenting at a tertiary care hospital in India. Babies underwent hearing screening using Transient Evoked Otoacoustic Emission (TEOAE) and Automated Auditory Brainstem Response (AABR) from November 2009 to September 2011. It was a cross-sectional study carried out at our institute involving 500 babies (≤2 y). To identify the high risk babies, Joint Committee on Infant Hearing (2007) High risk registry was used. In our study 110 (22%) babies belonged to high risk category and 11(2.2%) of total screened babies had significant hearing loss. Total number of babies who passed the initial screening with TEOAE was 284 (56.8%). On diagnostic AABR screening of TEOAE REFERRED babies, the babies with no risk factor showed normal AABR tracings whereas from among those with one or multiple risk factors (110 babies), 11(10%) showed different levels of hearing impairment. Hearing loss was highly associated with Neonatal Intensive Care Unit (NICU) admission i.e. 8/11(72.7%), followed by Low Birth Weight (LBW) and hypoxia (6/11 i.e. 54.5% each). Hearing loss is more common in those babies with risk factors (majority being NICU admission, LBW and hypoxia). OAE and ABR screening of infants at risk for significant hearing loss is a clinically efficient and cost effective approach for early detection of significant hearing loss.

Hearing Screening Using Auditory Steady State Responses Obtained by Simultaneous Air- and Bone-Conduction Stimuli

Introduction and objectivesMinimising false positives rates is an important goal of universal newborn hearing screening programmes. An adequate way for reaching that goal could be differentiating between transient conductive hearing losses (false positives) and permanent sensorineural hearing impairments (true positives) by means of a methodology that studies electrophysiological responses obtained using both air- and bone-conduction stimuli.Our objective was to evaluate the efficiency of an automated hearing screening test based on auditory steady state responses obtained using simultaneous air- and bone-conduction stimuli. MethodsA sample of 80 high risk babies less than 2 months of born were screened using the automatic screening test. A confirmatory clinical and electrophysiological evaluation was used as the gold standard. ResultsThe estimated diagnostic efficiency of this screening test was equivalent (100% sensitivity and 97.7% specificity) to the efficiency reported for otoacoustic emissions and automated auditory brainstem responses. The introduction of bone conduction in the screening reduced the false positive rate from 13.3% to 2.2%. The test duration was 5.3 (±1.9)min. In 34% of babies only one repetition of the test was needed to raising the result. ConclusionsThe screening test performed quite well in this initial clinical trial, differentiating transient conductive hearing losses from permanent neurosensory impairments and improving the diagnostic efficiency of auditory steady state responses.